Individual
KEVIN JUDE SHANAHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8321 W NORTH AVE, MELROSE PARK, IL 60160-1669
(708) 681-2298
Mailing address
8321 W NORTH AVE, MELROSE PARK, IL 60160-1669
(708) 681-2298
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085009116
IL
Other
Enumeration date
03/11/2022
Last updated
09/19/2022
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